Corruption In Egypt’s Medical Schools — Part 4

Last updated on Nov 27, 2008

Introduction

Welcome to the 4th part of the “Corruption In Egypt’s Medical Schools” series. This new title replaces the old one “Corruption in Universities of Egypt” because of reasons mentioned in that post .

The last part was up on May 9th of 2006, more than 2 years ago. You may wonder where I’ve been these past 2 years and why I haven’t written something since. The answer is that 1. I thought I shouldn’t write such things because they bring me down, but then I think I’ve become mature enough to change my mind, and 2. there wasn’t new ‘corrupt’ things to talk about. But now that I’ve finished a 12-month clinical course, a brand new exhibition of corruption, especially regarding doctors, was ready to be opened to visitors online, and I couldn’t let this chance go. A few negatives have been there since day 1 in my school, though, like the exam room conditions.

In fact, I wrote a short paragraph a few months ago, but I was too busy to complete it:

You may not believe it, but I have not heard any heart sounds except mine after spending 3 months attending in the Cardiology department in my medical school in Egypt! I haven’t also had a chance to let my fingers slip on the lower border of the liver nor ballot the kidneys.

That’s very common in the highly aggrandized Egyptian medical schools. The system is severely corrupt with lecturers not attending or arriving late, students (up to more than 50%) not attending due to incompetent administration or overcrowdedness, very little practical application with no chance for students to apply clinical knowledge in history-taking or examination, very hostile attitude towards curious students, and patients depressed, ill-treated, and not willing to be examined with no education or supervision by residents.

I chose a somewhat comical way in writing this article. I thought I’d give it an exciting flavor so that people would keep reading such atrocities, and not be turned off, puke, and leave. So, here we go.

Air Forbidden

Some (not all) of our exam rooms are devoid of any type of air sources.
Air; this vital, freely-available source of life seems to be too much for us, poor exam-takers. I’m not greedy. I don’t want a high-end air conditioner. I don’t even want a fan. I just want an open window; not for me, but for my poor lungs. At the same time the dean or another professor is sitting on his comfortable chair with the air conditioner on. No, I’m not envying them. They do deserve it.

I remember that in my opthalmology final exam last year it was incredibley hot and humid (the exam was in July), and I was literally on the verge of shock. I had to leave early because of that.

Miserable Desks

The desks we take the exams on make you want to laugh just when you see them (and then cry at the time of the exam). Numerous models are there; short, tall, and oblique. There are those with holes in the middle, and those with uneven surface, which makes writing on them in a good handwriting a real challenge. There are also interesting combinations with chairs; high desks with short chairs is one. After a while you don’t feel your bottom at all, then you discover that it’s not even on the chair anymore; it has risen. We’re not demanding golden desks here, but normal ones would do! Those are not normal in any way!

Why Not Terrible Chairs As Well?

There’s a famous type of wooden chairs here in Egypt. It’s the one yellowish or brownish in color, with a pharaoh face on it, and has a thick edge all around the base which guarantees sciatica to anyone who sits on them for more than 10 minutes. This one is the widely-used chair in our exam rooms. Moreover, the chairs are occasionally decorated with long protruding nails on the sides. Annoyingly creaking chairs also exist. When sitting on one, the whole experience becomes a worrisome anticipation of when the chair will fall to pieces while you’re on it. And what about the exam? Who’s talking about exams here?

MCQ Corruption/Technical Issues

MCQ exams are increasingly introduced in Egypt’s medical schools, and while it’s initially a good thing, other numerous things pull it from being genuinely useful.

Good MCQ questions are designed to assess what the student understands, and not what they memorize. However, here they ask about normal cell counts, enzyme levels, and the like. Those lab results should be given to the student as a guide to diagnose other cases. But who’s going to memorize numbers of hundreds of serum enzyme levels? And why?

This aside, I daresay that MCQ exams in medical schools in Egypt are totally worthless as a whole. The reason is that each department releases an MCQ book with all the questions and answers that will be in the exam. Identical questions. All you need to do is memorize that book. Some students even memorize the choice numbers! The reason then for the MCQ thing at all is questionable. Most probably, they’re introducing them for administrative reasons. Reasons where personal profitability, not student’s sake, comes first.

They also introduced computerized marking of the MCQ answer sheets. There are columns of empty circles which you are supposed to fill in with a pencil. If you fill in more than one circle in one answer, you get a zero. This is to eliminate people trying to get any of them right by luck. Well, this is a great move. However, technical problems, or rather neglect, ruins this advancement.

On several answer sheets there were ill-placed stamp marks on the circles. In my case, one column of the circle E, was covered by the edge of a stamp mark. The computer will not differentiate between a stamp mark and a pencil mark, and so if I answer anything other than E, I get a zero. A lot of people noticed early enough and demanded another clean sheets as replacements. Of course this takes time, and in the middle of the exam, it’s not the most fun thing to be through. In my case, by the time I noticed this I was almost finished with answering, so there was no way for me to mark all those circles again. I lost 4 marks because of that. Thankfully, this happened only once for me.

Some question papers also had mistakes:

• A question with the correct answer F, but the answer sheet numbering ends at E.
• Questions missing crucial text like “except” at the end of the question.
• Repeated questions.

What the instructors do is yell in the microphone saying that this should be that, or even cancel those questions beyond correction.

And so I concluded that our staff here in Egypt and technology just doesn’t get along. Who’ve ever imagined that such technological advancement of marking could end up with people losing marks for nothing? And who are those people responsible for the ill-placement of those stamp marks? Where are those people who revise the integrity of the question papers and answer sheets before they reach us?

Rude Behavior Of School Doctors

Doctors are evil and rude in sci-fi movies and comics, where they do evil experiments on humans for reasons like conquering the world. But they are supposed to be kind and polite in real life, or this is at least what we’re told. In Egypt, not only people are rude, but also doctors are.

In my clinical exam this year, there were 5 cases to be examined on. They’re all laid side by side in one room. In front of each patient, there’s a doctor. They’re usually the big professors. The doctors ask you about some findings in the case, or order you to perform a clinical test, or provocate a sign. If you get something wrong, some doctors are rude enough, to do the following:

1. Laugh aloud at you.
2. Tease you rudely by saying something like: “Yes, yes, keep going” or “Keep making up”.
3. Insult you with terrible insults.
4. Call the doctors on their sides and joke loudly with them about what you said as if they’re in a bar.

Thankfully, I got only one of those; no. 4. My friends got more (lucky they). Imagine how distressful such situations are. You’re not just being made fun of; you’re in the middle of the exam, and you’re supposed to answer more questions that follow.

Well, I have the right to make exam mistakes without being punished physically or psychologically. The only punishment I can get is subtracting marks from my score. Those rude doctors should learn that. Sometimes I even get the feeling that I’m talking with a sick person who needs treatment, not with a doctor.

Corrupt Attitude Of School Doctors

Many doctors who are to discuss with you in the clinical or oral exams have weird attitudes:

• Asking you about their names (and getting really upset if you happen to not know them). In fact, most doctors have the habit of not introducing themselves.
• Asking you in detail about what they’ve discussed in their lectures (and also getting mad if your reply is negative).
• Joking inappropriately in the middle of the exam.
• Asking you non-medical questions (like religion, for instance) and giving more marks to those who answer them.
• And finally giving you the chance to give money to the patients as a bribe in the middle of the exam.

Some doctor jokingly discussed the meaning of my name in a rude manner. My name is pretty recent, and was not known to the Egyptians until some years ago, so may be it sounded ‘gay’ to that corrupt old doctor and he wanted to imply that.

And why should I know the name of doctors and what they discuss in their lectures? In a public school like that, and with a total count of around 1,000 student per year, I have the right to not attend those useless outdated lectures. The doctors don’t know me, and so it’s expected that I wouldn’t know them. One-sided interaction never succeeds. Where I get my information from is up to me. I attend the clinical rounds because they’re way more useful than those sleep-inducing lectures. So in short, they should not assess my level by asking me if I know their names; rather, by how I perform in the exams. The former is just a cheap childish way of assessment that I’ve never heard about before.

Weak Clinical Teaching

Our clinical training was generally poor in quantity and quality. Some reasons are below:

• Many teaching doctors simply would not attend.
• Clinical cases were very few, and were usually of the same disease (e.g. chronic liver disease).
• We were denied access to the patient wards all the time, and we complained to the doctors about it. But all in vain.
• There was no such thing as regular rounds.
• We asked some doctor to let us auscultate the heart in some case, but he said, “Check them out in a cardiac simulator on the computer”.
• Many doctors would forget all about the clinical part, and discuss purely academical topics like “types of macrocytic anemia”.

Luxurious Halls For The Pharaohs

The anatomy department is undergoing massive reconstruction these days. A luxurious department, suitable for a Great Pharaoh, is on the way to existence. The walls and the floor are being covered with expensive porcelain. The roof is decorated with numerous high-quality antiques. The doctors rooms are also part of that reconstruction. Every single place in the department is getting upgrades except those parts related to the students, and most importantly here, the anatomy museum.

The museum is always home to tens of students studying different specimens. Since my day, when I was in the 1st and 2nd years, neon lamps were not even enough to offer adequate lighting, and God only knows how much eye-strain I had. Not to mention how old the specimens are and how badly preserved they are, which makes reviewing them a real pain.

Now we come to the crucial questions:

1. Who offered all that money?
2. Who has taken the decision to reconstruct the halls in such luxurious way? and why?
3. Who has taken the decision to NOT reconstruct the anatomy museum?
4. Shouldn’t a portion of this money have been spent on the anatomy museum?

Verdict

Well, I haven’t expected this article to be such lengthy, but I guess being in a vacation gave me the time to add more bits.

I think I have to clarify something. Many people have told me that I’m just showing hatred towards my country, or to be specific, towards my school. And that I’m doing nothing but showing it as a corrupt hell to people around the world. This actually is incorrect. I don’t hate my school as much as I have the urge to criticize it. It’s like an itchy lesion on your skin, you can’t help but scratch on it every now and then. I criticize it because I want it to be better for future generations. I want us to boldly open our eyes to what’s wrong. I’m actually very neutral. You can say I criticize for the sake of criticism itself. Because I think criticizing is the correct way of living. I criticize myself and my family. I criticize everything my eyes land on. And genuine criticism is not just saying, “This sucks!”, but listing why it is so, and how to repair it. The former is just a form of dissing.

Some people have told me that I shouldn’t expect more from such a free medical education. And I guess they’re partly right, but I’m sure we can avoid and eliminate many corrupt things in our medical schools without the need of money. We can be poor but polite and honest and sincere, can’t we?

This is probably the one article before the last in this series. I expect I’ll be writing another one during or after my internship to show its negatives. And by having done this, I’ve not just watched the movie, eaten the popcorn, and then gone home; I’ve also commented on it for next viewers.

See you in the next part, probably a year or more later.